Provider Demographics
NPI:1679689400
Name:OLSON, JAMES RAYMOND (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RAYMOND
Last Name:OLSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:685 BLYTHE STREET CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28739-4087
Mailing Address - Country:US
Mailing Address - Phone:828-697-6000
Mailing Address - Fax:828-697-6003
Practice Address - Street 1:685 BLYTHE STREET CT
Practice Address - Street 2:SUITE A
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28739-4087
Practice Address - Country:US
Practice Address - Phone:828-697-6000
Practice Address - Fax:828-697-6003
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC52311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice